Ultrastructural changes in tension zones of rat molar periodontium incident to orthodontic tooth movement. The purpose of this study was, by introducing transmission electron microscopy, to clarify fine details of tissue reactions in the periodontal ligament on the tension side. A preliminary investigation was undertaken on nine rats in which experimental tooth movement lasted 2 days, 14 days, and 28 days. It was hoped that these new observations might help in the planning and directing of further studies. A marked increase of interstitial spaces between the formed ligament structures of the periodontal ligament was characteristic of the initial phases of tension. The cells and the endoplasmic reticulum within the cells were spindle shaped and oriented in the direction of strain. Occasionally, collagen fibrils were observed within the cytoplasm of fibroblasts. During experimental tension a higher prevalence of elastic fibers was observed and new details of the reaction of collagen fibrils were obtained. The new cementum and bone deposited during the experiment were studied. The preliminary study indicated that electron microscopy may become a valuable tool for the study of the tension side.


Hyoid and muscle changes following distal repositioning of the tongue.


Measurement of tooth movement.

Measurement of tooth movement. 1. Tooth movement relative to the alveolar bone can be precisely described only by superimposing on fixed points in the bone. Implants are the best known way today. Over short-term studies laminagraphy and the use of bony trabeculations are also useful. Remodeling occurs extensively on bony surfaces, making them too labile for use as stable landmarks. To project small amounts of tooth movement based on the use of such methods is so questionable as to represent little better than a guess or a clinical impression. 2. Growth can be separated into vertical and anteroposterior vectors with respect to the dentition. Since the occlusion is the concern, orientation of vertical and anteroposterior vectors to the occlusal plane is a reasonable baseline. The vertical and anteroposterior dental changes may not show a linear relationship in the anterior and posterior parts of the mouth when jaw rotations are occurring. 3. Growth can be disproportionate in either the vertical and/or the anteroposteroir plane of space. If the vertical increments of the anterior face differ from the vertical increments at the posterior face, mandibular rotations occur. This growth is accompanied by dental compensations that tend to mask the rotation. Therefore, open bite and deep bite are frequently skeletal growth problems. 4. Disproportional forward growth of the maxilla or mandible in an anteroposterior direction can lead to Class II or III relations. The growth that leads to Class II or Class III is accompanied by dental migrations that tend to mask this disproportionate growth. Orthodontic treatment of growth disproportionalities usually represents attempts to make the teeth further compensate. If surgical options are elected, the dental compensations should be removed prior to surgery in order to achieve a full surgical correction. 5. The teeth tend to move and grow in the opposite direction of the growth disproportionality. The teeth tend to mask the disproportionality. Thus, in an open bite, the incisors tend to move vertically further than in deep bites. Vertical imbalances may be more difficult to mask. Backward rotation of the mandible requires more vertical movement at the incisor than at the molar just to maintain vertical incisor relationships.


A dynamic evaluation of human occlusion.


Effect of experimental microglossia on craniofacial growth. The present experiment provides data on the morphogenetic effects of experimentally produced microglossia (by glossectomy) on the maxillofacial skeleton of the rat. Nineteen males and nineteen females subjected to this surgical procedure were compared, using an analysis of variance, with an equal number (thirty-eight) of nonoperated littermates of both sexes, which served as a control group. The surgical procedures were performed on the animals when they were 21 days old. They were killed 64 days later, at the age of 12 weeks, or at the end of the growing period. It was demonstrated that the activity of different proliferating maxillofacial sites was significantly reduced (p less than 0.01 and 0.001) in all three dimensions. This affected both the basal and alveolar bones at the same time.


American Board of Orthodontics defines current standards and requirements.


Infections or neoplasm as causes of prolonged fever in cancer patients. Thirty-six consecutive patients with cancer who met the classical criteria for fever of unexplained origin (FUO) were identified. A total of 18 patients had infections including all 12 with leukemia, four of 12 with Hodgkin's disease, and two with solid tumors. Fungal infections were found in nine: histoplasmosis, three; candidiasis, three; and aspergillosis, systemic sporotrichosis, or cryptococcal meningitis, one each. Six patients had unresolved pyogenic infections and one had tuberculous pericarditis. Two others had viral etiologies. Granulocytopenia was significantly more common in the FUO patients with documented infections. Clinical or laboratory abnormalities suggesting involvement of a specific organ or organ system provided important clues indicating infections. Morphological examination of biopsy specimens, with cultures, was the best method for diagnosis. In 18 patients, 12 with lymphomas and 6 with solid tumors, only the neoplasm appeared responsible for the fever. In these patients there was a paucity of abnormalities indicating organ system involvement with infection. Regardless, physicians' diagnostic efforts should not be deterred in such patients. Repeated thorough evaluations for infection are warranted.


Editorial: Orthodontosie, orthodontics, or dentofacial orthopedics.


Editorial: Seriously handicapping orthodontic conditions.


Letter to the editor: Third molar enucleation reassessed again.


Premolar enucleation.

Premolar enucleation. A study was made on 27 cases where enucleation of four first premolars was performed simultaneously without introduction of mechanical devices to influence space closure. The results suggested that: 1. Enucleation of premolars can be used to minimize the severity of crowding in arch-length deficiency cases. 2. There is no damage to the remaining teeth and alveolar process when enucleation is accomplished with good surgical technique. 3. The average amount of lingual tipping of the mandibular incisors in approximately four years subsequent to the enucleation procedure was 4.1 degrees. 4. This amount of lingual tipping compares quite favorably with the amount of lower incisor uprighting experienced during growth and could not be considered excessive. 5. The mandible does tend to rotate in a counterclockwise manner following enucleation of four first premolars without appliance therapy. This rotation was considered significant in comparison with the amount of rotation that could be expected from an untreated sample. 6. If orthodontic treatment is planned, the enucleation of the manddibular second premolars in borderline extraction cases to avoid excessive lingual tipping of the mandibular incisors would seem to be questionable. 7. Various combinations of enucleation and tooth extraction may be helpful in treatment planning. 8. With judicious timing the enucleation of four first premolars can minimize the severity of the malocclusion  simplifying appliance therapy if proper diagnosis and good surgical technique are employed. 9. Although conventional serial extraction may accomplish similar ends, it would appear that enucleation would offer some advantages in terms of autonomous adjustment of the mandibular incisors and root positioning of mandibular cuspids. 10. Enucleation cases usually require fewer traumatic surgical procedures and less supervision by the orthodontist. 11. The parents should be informed that serial extraction procedures including enucleation may simplify but will not eliminate the need for appliance therapy.


Growth of the nasopharynx and adenoid development from one to eighteeen years. 1. The dimensions of the nasopharynx, the adenoids and the nasopharyngeal airway were analyzed in twelve subjects selected from the longitudinal growth study of the Child Research Council of Denver. 2. The nasopharyngeal area was defined by four skeletally defined lines which formed a trapezoid. The nasopharyngeal area was divided into an adenoid-pharyngeal wall and airway areas which were measured using a polar planimeter. The trapezoid analysis proved to be a useful technique for quantification of nasopharyngeal dimensions. 3. The growth of the nasopharynx from nine months to 18 years was established and reflected the different growth patterns of males and females. 4. The sphenoid line/palatal line angle (theta) and nasopharyngeal depth were established early in life and contributed little to the increase of nasopharyngeal area. The increase in nasopharyngeal area corresponded to the descent of the palate from the sphenoid bone which increased nasopharyngeal height. 5. Restriction of the nasopharyngeal airway frequently occurred during the pre- and early school years due to adenoid hypertrophy which exceeded the usual increase in nasopharyngeal capacity. 6. The nasopharyngeal airway increased during pre- and early adolescence due to the concurrent increase in nasopharyngeal area and adenoid involution. 7. Ten subjects had a history of tonsil and adenoid surgery, but of these only five demonstrated what appeared to be complete removal of nasopharyngeal and adenoid tissue as seen on postsurgical radiographs. The possibility that surgical technique may be the critical factor in the completeness of adenoid removal is presented. 8. The mandibular angle did not apear to be affected by periods of nasopharnygeal airway obstruction is any of the subjects in this study. However, an expanded longitudinal study would be required to determine if restriction of the nasopharyngeal airway influences facial form and occlusion.


Hypoplasia of the middle third of the face -a morphological study. The aim of this investigation was to examine the morphological characteristics of patients diagnosed as having hypoplasia of the middle of the face. The study group consisted of lateral skull X-rays of 31 patients, aged 8.4-18.1 years, with hypoplasia of the middle third of the face. A control group of 31 patients matched according to age and sex was used. The study group showed the following significant differences: short anterior cranial base, small cranial base angel, reduced sagittal development of the nose, straight profile, retrognathic maxilla, short maxilla, reduced sagittal depth of the nasopharynx and reduced vertical growth of the maxilla. The results indicate a reduction in dimensions of the entire nasal airway which, it is suggested, could have an adverse effect on nasal breathing. In addition, correlation analyses for the mandibular plane angle (ML/NSL) in relation to variables of importance in mode of breathing 1) the sagittal depth of the nasopharynx, and 2) the inclination of the nasal bone, have confirmed earlier studies showing that a change in the mode of breathing can affect the development of the entire craniofacial complex. The clinical aspects of these findings are discussed.


Anterior open bite and oral port constriction. Intraoral air pressure and rate of oral airflow were measured simultaneously during fricative sound production in ten subjects with anterior open bite and ten subjects with normal occlusion and speech. From these measurements the area of oral port constriction was calculated and the values compared within and between the two groups. Findings revealed that: (1) The area of oral port constriction was very consistent and reproducible in subjects with normal speech production and normal occlusion. (2) The area of oral port constriction was significantly larger in open-bite subjects compared with control subjects for all sounds. (3) Severe anterior open-bite subjects with a vertical defect over five millimeters were found to produce significantly larger oral port openings than those with only moderate open bite (3-5 mm) for most sounds. (4) A direct correlation between the degree of open bite and the area of oral port constriction was found. As the amount of open bite increased, the area of the oral port increased, especially in the severe open-bite group (5 mm and over).


Unilateral mandibular hyperplasia associated with a lateral tongue thrust.


Radionuclide imaging of hard and soft tissues of dog jaws under heavy orthodontic forces. Rectilinear scanning with soft tissue, vascular and skeletal imaging agents was used to study the effects of heavy orthodontic forces on the tissues of dog jaws. A coil delivering either a 300 or 600 gram separating force to two adjacent lower right posterior teeth was inserted in each of four dogs. The animals were scanned with the three imaging agents three to four week after insertion of the coils. Only the skeletal agent, Tc-PP, was selectively concentrated in tissues adjacent to the stressed teeth. Tissue distributions of this agent, determined from autopsy samples, revealed that, although all the hard and soft tissues examined contained measurable amounts of Tc-PP, only alveolar bone demonstrated increased uptake of the agent as a result of the applied forces. Tc-PP concentrations were highest in areas of pressure and tension. The total area of alveolar bone showing increased uptake of Tc-PP was larger with 600 than with 300 gram coils. There was close agreement between rectilinear scanning and the tissure distributions of Tc-PP with respect to both the size and anatomic location of the alveolar bone regions affected by the separating forces. This technique may have useful applications in orthodontic research.


Letter: Methicillin-associated thrombocytopenia.


Treatment of an open-bite malocclusion complicated by clefts of the maxilla and mandible. This is a case presentation of a young girl with a severe Class II, Division I open-bite malocclusion. Her orthodontic problems were further complicated by clefts in both her maxilla and mandible. A cleft palate team evaluation brought several systemic and local problems to light which necessitated their correction prior to the commencement of any orthodontic therapy. Her diagnosis and treatment have been discussed here with special emphasis on the problems peculiar to children with oral clefts.


Referent communication in schizophrenia: the perseverative-chaining model.


Letter: Pericarditis in a case of early daunorubicin cardiomyopathy.


The arousal function of central catecholamine neurons.


Introduction: myasthenia gravis in perspective.


Single-muscle-fiber recording of the jitter phenomenon in patients with myasthenia gravis and in members of their families.


The results to be expected from electrical testing in the diagnosis of myasthenia gravis. The purpose of this study was to derive numerical data concerning the probability of diagnosing myasthenia gravis by electrical tests, employing repetitive stimulation of motor nerves. This was done by recording the compound muscle action potential (CMAP) from 80 patients with clear-cut myasthenia gravis, using a number of different, reportedly useful, testing techniques. In 95% of these patients, the diagnosis could be documented by the careful application of rather simple methods, providing several muscles, including a proximal one such as deltoid, were studied.


Experimental autoimmune myasthenia gravis and myasthenia gravis: biochemical and immunochemical aspects. Stucture of acetylcholine receptor protein (AChR) purified from Electrophorus electricus (eel) by affinity chromatography is described. AChR is detected in extracts from human muscle, rat muscle, and rat thymus. Rats immunized with eel AChR develop humoral antibodies, a small fraction of which recognize AChR  from rat muscle. Rats immunized with AChR exhibit myasthenia, but those immunized with denatured AChR do not. Immunoglobulin fraction of antisera to eel AChR can block the activity of AChR in electroplaques. Sera from patients with myasthenia gravis contain antibodies to AChR  from human muscle detectabe at an average value 300-fold the background level in sera from nonmyasthenics. Relationship of thymoma and disease intensity to antibody titer is examined. The chronic phase of EAMG appears a good model of MG, since in both cases similar concentrations of 7-S immunoglobulin against determinants on muscle AChR other than the toxin binding site are found. Assay of anti-AChR antibody in sera from MG patients using AChR from rat muscle gives titers 10%-15% of those obtained using AChR from human muscle, and using AChR from eel gives negligible titers. The assay method described for assaying antibodies against AChR from human muscle is suggested as a diagnostic test for MG.


Experimental autoimmune myasthenia: clinical, neurophysiologic, and pharmacologic aspects.


End-plate potentials in experimental autoimmune myasthenia gravis in rats. Rats inoculated once with nicotinic acetylcholine receptor and adjuvants had two episodes of weakness, the first being acute and transient, starting on day 8, and remitting in a few days, the second, chronic, progressive, and appearing  after day 20. In the acute phase, the compound action potential and twitch evoked in weak forelimb muscles by maximal nerve stimulus were greatly reduced. Nerve action potentials were normal, however, and the muscle responded to direct electrical stimulation. Using intracellular microelectrodes, miniature end-plate potentials were difficult to find and often were low in amplitude. Many fibers were functionally denervated; no action potential or end-plate potential was  evoked by nerve stimulus, although the muscle fiber responded to direct stimulation. In fibers with EEPs the number of acetylcholine quanta released by nerve impulse, the store of quanta readily available for release and the mobilization rate were low. The diaphragm was similarly, but less severely affected. Recovery from the acute phase occurred in a few days with restoration of the response of forelimb muscle to nerve stimulus, even though MEPP amplitude remained low. In the chronic phase, in both forelimb muscle and diaphragm, MEPP were more easily found, but in all rats MEPP amplitude was below  normal whether or not there was weakness or a decrement in the EMG. The number of quanta released by nerve stimulus, the store, and the mobilization rate of quanta were normal in all animals.  The titer of antibodies ot syngeneic acetylcholine receptor was elevated in all chronic phase animals. The chronic phase is like myasthenia gravis, but rats with MEPP amplitudes as low as those in patients with MG frequently were not weak, because the number of ACh quanta released per nerve impulse is greater in the rat than in man.


Antibodies to acetylcholine receptors in rabbits: immunochemical and electrophysiological studies. Acetylcholine receptors (AChR), purified from electric eel and Torpedo by affinity chromatography using a synthetic quaternary ammonium ligand, bound 10 nmole alpha-bungarotoxin (alpha-BuTx) per mg of protein and demonstrated a common subunit. Rabbits, immunized with either eel or Torpedo/AChR, developed flaccid paralysis barely altered by anticholinesterases and died 48 hours after the first sign of paralysis. In paralyzed animals, repetitive stimulation at low rates induced a 50% to 90% decrement of evoked potentials, temporarily reversed by edrophonium. Extracellular and introcellular MEPP amplitudes were 40% to 50% of controls. Serum and isolated IgG formed single immunoprecipitin lines against the antigens. AChR-antibody complexes did not bind alpha-BuTx, whereas alpha-BuTx-AChR complexes bound antibody if the antibody was specific for that AChR. Torpedo and eel AChR showed partial idenity with both antisera. Rat diaphragms and eel electroplax incubated with antisera to Torpedo and eel AChR showed a 50%-60% reduction in carbamylcholine depolarization. These studies demonstrate differences between eel and Torpedo AChR induce a block in neuromuscular transmission in rabbits with features of myasthenia gravis.


Experimental myasthenia in rabbits: biochemical, immunological, electrophysiological, and morphological aspects.


The biologic significance of HL-A antigen markers in myasthenia gravis.


Experimental acetylcholine blockade of the neuromuscular junction. Effects on end plate and muscle fiber ultrastructure. To investigate the effect of acetylcholine on the formation and maintenance of the end plate, presynaptic (hemicholinium-3 and botulinum toxin) and postsynaptic (curare and alpha-bungarotoxin) blocking agents were injected into the amniotic sac or chorioallantoic circulation of chick embryos during different stages of their development (days 3 to 11, 3 to 18, and 12 to 18). Tntercostal or anterior and posterior latissimus dorsi muscles were examined by electron microscopy. Regardless of the duration of treatment, the type of agent, or the type of muscle, nerve ingrowth into muscle and end-plate formation were not arrested and the ultrastructure of nerve terminals and postsynaptic regions was normal. By contrast, muscle fiber ultrastructure was affected by acetylcholine blockade if continued beyond day 11. By day 11 both treated and  control muscles were composed primarily of myotubes. Muscles treated beyond day 11 showed impaired fiber differentiation and persistence of many myotubes. In addition, many fiber regions contained unassembled fine filaments intermingled with other organelles. In hemicholinium-3 treated muscles ther were also mitochondrial abnormalities and an increased number of lipid droplets. The findings suggest that the altered structure of the neuromusclar junction in myasthenia gravis is not due to the lack of a trophic effect of acetylcholine. The impaired fiber maturation in the chick embryos may be related to the lack of acetylcholine mediated fiber activity.


Gallium scans in myasthenia gravis.

Gallium scans in myasthenia gravis.


The motor end plate in myasthenia gravis and in experimental autoimmune myasthenia gravis. A quantitative ultrastructural study. Neuromuscular junction ultrastructure in rat forelimb digit extensor muscle was sequentially and quantitatively investigated in experimental autoimmune myasthenia gravis (EAMG). Experimental animals received a single dose of highly purified eel-electroplax acetylcholine receptor protein plus complete Freund's adjuvant and B. pertussis organisms. During the first 7 days (latent period) after immunization the experimental end plates remained normal. Between day 7 and 11 (acute phase) mononuclear cells infiltrated those regions of muscle where the end plates were located and the was sudden degeneration of the postsynaptic regions with splitting  away of the abnormal junctional folds from the underlying muscle fibers. Macrophages entered the gaps arising between the muscle fibers and the separating postsynaptic folds and removed the degenerating folds by phagocytosis. The nerve terminals were displaced from their usual location but maintained their structural integrity. After day 11 (chronic phase) the inflammatory reaction subsided and the nerve terminals returned to the highly simplified postsynaptic regions. Subsequently the postsynaptic folds were reconstituted and again they degenerated. The degeneration involved  especially the tips of the folds where acetylcholine receptor sites are concentrated. Immature junctions with poorly differentiated postsynaptic regions and nerve sprouts near end plates were also observed. In two animals that relapsed on day 27 and 33, respectively, degeneration of the postsynaptic folds was more intense than in the remaining animals that had not relapsed during the chronic phase. Morphometric analysis of the end plates demonstrated significant decreases in the postsynaptic membrane length, in the postsynaptic membrane density  and in the postsynaptic to presynaptic membrane length ratio in chronic EAMG. In addition, the concentration of synaptic vesicles in the nerve terminals was increased in acute and chronic EAMG while the nerve terminal area was decreased in acute EAMG. The alterations in the nerve terminal may be secondary to the postsynaptic changes. The postsynaptic region is the primary target of the autoimmune reaction in EAMG and the ultrastructural and morphometric abnormalities of the end plate in the chronic phase of the syndrome closely resemble those which have been observed in human myasthenia gravis.


Effects of normal and myasthenic serum factors on innervated and chronically denervated mammalian muscles.


Long-term prednisone followed by thymectomy in myasthenia gravis. The present series of thirty patients has  led us to certain conclusions concerning the management and treatment of patients with myasthenia gravis. The use of cholinesterase inhibitors alone is reserved for those patients with purely ocular myasthenia whose deficits can be satisfactorily corrected with those agents. Some of those with  ocular involvement  may be disabled; and in light of our excellent results with that small group, as well as similar findings presented by Fischer et al., patients with disabling or refractory ocular myasthenia should be considered for treatment with prednisone. All other patients with myasthenia are given a course of  oral corticosteroids (prednisone) initially at high doses, with subsequent tapering to maintenance, alternate-day low-dose therapy. Cholinesterase inhibitors are used as needed while the patient is receiving corticosteroids. We now anticipate that patients will exhibit sustained improvement within the first  two weeks, reaching maximal improvement at about three months. Exacerbations of myasthenic weakness may occur in the early phases of treatment. Such exacerbations have been commonly mild and occur with a mean onset at 5 days, and have a mean duration of 6 days. Most patients have been able to tolerate an alternate-day schedule of prednisone therapy when maintenance levels were achieved. The effective maintenance dose has been determined as the smallest dose of prednisone which allows the patient to maintain maximal improvement. Following the establishment of maximal improvement, patients have been considered for thymectomy. In our experience, the sternum-splitting procedure has been tolerated extremely well by patients exhibiting marked imporvement or remission while on corticosteroids. In those patients where thymectomy is contraindicated, irradiation of the thymus might be considered. Patients are continued on maintenance steroid therapy following surgery for a period of time that has been arbitrary. Currently, we consider an attempt to discontinue steroids at approximately one year reasonable. Should the patient relapse after discontinuation of the medication, oral corticosteroid treatment is reinitiated. Consideration is given to the possibility of recurrent thymus in patients who repeatedly fail to maintain a remission when steroids have been stopped. Our experience has not permitted us  to draw firm conclusions concerning how long a time high-dose daily steroid treatment should be continued in patients who show no favorable response to that therapy. Other modes of treatment, such as courses of parenteral ACTH, methyl prednisolone, dexamethazone, or antimetabolites might be considered if there is no response after 12 weeks of high-dose, daily corticosteroid therapy.


Edrophonium infrared optokinetic nystagmography in the diagnosis of myasthenia gravis.


Saccade fatigue and response to edrophonium for the diagnosis of myasthenia gravis. Maximum velocity and amplitude of repetitive ( 1-per-second) 30 degrees saccadic eye movements were quantitatively assessed for 4 minutes before and after intravenous edrophonium chloride as a diagnostic test for myasthenia gravis. Atropine was given initially to suppress muscarinic side effects. Eye movements were recorded by electrooculography and a digital computer identified saccadic eye movements and plotted amplitude-velocity relationships. When compared with control subjects, eleven of twelve patients with proven MG had a significant increase in saccade amplitude and/or maximum velocity after edrophonium chloride. Only three of twelve proven MG patients had clinically apparent extraocular muscle weakness. The initial period of fatigue improved the sensitivity of the test in those patients who began with normal saccade amplitude and maximum velocity. Two of the patients with positive saccade fatigue tests had no change in optokinetic nystagmus amplitude before and after edrophonium chloride. It is concluded that, quantitative assessment of repetitive large angle saccades before and after edrophonium chloride is a sensitive test for extraocular muscle involvement in MG.


Introductory remarks: the challenge of the granulomatous disorders in man.


Oral corticosteroids in the treatment of ocular myasthenia gravis.


Acquisition of tuberculin sensitivity after injection of dialyzable transfer factor in sarcoidosis.


Morphology and distribution of the cells of a sarcoid granuloma: ultrastructural study of serial sections.


Kinetics of monocyte receptor activity for immunoproteins in patients with sarcoidosis. Peripheral blood monocytes from patients with active sarcoidosis have increased ability to bind IgG-antibody-coated and C3-coated erythrocytes. Binding of monocytes from sarcoid patients is inhibited less than for normals with IgG1 and IgG3 in the fluid phase. Following phagocytosis of latex particles, monocytes from sarcoides patients retain the capacity to bind IgG-coated erythrocytes, whereas monocytes from normal individuals show disappearance of IgG receptors followed by recovery during a 6-8 hr period. Preliminary studies (8 patients) of monocytes from patients with Crohn's disease show some increase in binding of IgG-coated erythrocytes as compared with normals; this increase, however, is less than for sarcoidosis patients. Preliminary experiments with multistranded polynucleotides (poly I:C:U) show increased activity for normal monocytes and no detectable effect on IgG receptor activity for sarcoid monocytes. Thus peripheral blood monocytes of patients with sarcoidosis have increased IgG and C3 receptors sites, suggesting activation of monocytes in this disease and perhaps in other granulomatous disorders.


The ornithosis complement fixation test in sarcoidosis.


Search for specific antibody in sera from patients with sarcoidosis.


Evidence for circulating immune complexes in erythema nodosum and early sarcoidosis. Twenty-two patients were investigated during acute attacks of erythema nodosum with a series of tests for circulating immune complexes. Nineteen had bilateral hilar lymphadenopathy and were considered to have sarcoidosis. Evidence of circulating immune complexes was found in 18, out of 22 patients (including 15 out of the 19 cases of sarcoidosis). The most frequent abnormality was the detection of elevated levels of C3 breakdown products (C3i), which were found in 14 out of 18 tests. The test results returned gradually to normal as symptoms subsided in 20-40 days, but 2 patients still showed abnormalities at 40 days despite the disappearance of symptoms. It is concluded that free immune complexes appear in the circulation during the early stages of acute sarcoidosis and gradually disappear as symptoms subside.


The nature and physical characteristics of a transmissible agent from human sarcoid tissue. In controlled experiments normal and immunologically deficient CBA mice were inoculated in footpads, intraperitoneally, or intravenously with whole fresh, fresh supernatant, and fresh filtered supernatant (0.2 mu) or with each of these homogenates after autoclaving or their further exposure to 60Co irradiation (2.5 MR). As controls, mice were inoculated with identically prepared fresh nonsarcoid homogenates by these same routes. Epithelioid- and giant-cell granulomas were present in viscera of mice given each fresh sarcoid homogenate by any of these routes 15 months after inoculation, but were not present in mice given nonsarcoid autoclaved sarcoid, or 60Co-irradiated sarcoid homogenate. Successful passages were achieved following the inoculation of whole or filtered supernatant (0.2 mu) sarcoid mouse tissue homogenate into footpads, intraperitoneally, or intravenously. The epithelioid- and giant-cell granulomas evolved slowly over a period of many months following the inoculation of sarcoid tissue or passage homogenates and persisted thereafter in association with Kveim reactivity. The transmissible agent is inactivated when homogenate prepared from human sarcoid or mouse sarcoid tissue is autoclaved or 60Co-irradiated, can be repeatedly passaged, and has been shown to pass an 0.2-mu membrane filter. It is therefore presumably viable and must approximate to the size of  a virus or be capable of being deformed so as to pass a filter of such a pore size (0.2mu), L forms.


The serach for viruses in sarcoidosis.

The serach for viruses in sarcoidosis.


Transmissibility of sarcoid-specific granulomas in the footpads of mice. Homogenate of 30 sarcoid lymph nodes was injected into the footpads of mice and 42% of the mice showed epitheloid-cell granulomas in the sites. However, the control lymph-node homogenates obtained from nonsarcoid patients also provoked similar granulomatous changes, although the positive rate was somewhat lower. In the granulomas a small amount of dust pigment remained, but no polarizing crystals were found in the sites or in the homogenate of either groups. No acid-fast bacilli, fungi, or other aerobic organisms were cultivated from the homogenate. Granuloma-formation activity remained after the homogenate had been sterilized in several ways and it existed in sediments of centrifugation of less than 2200 x g, but not in the supernate. The results seem to indicate that the granuloma formed in the footpads were the result of a local immunological reaction to the degenerated heterogenic protein of the injected and persistent homogenate.


Pulmonary function in stage I and II pulmonary sarcoidosis. Pulmonary function tests in 25 newly studied patients with Stage I and 19 with Stage II sarcoidosis revealed normal mean values in Stage I for all tests except DLCOSB. Mean values for VC, TLC, MMF, and exercise Pao, were abnormal in Stage II and significantly different from Stage I. There was a parallel difference in prevalence of impairment of these measurements and of DLCOSB as well. When the present results are compared with previously reported values for sarcoidosis patients with radiographic evidence of pulmonary fibrosis, progressive impairment is evident with later stages of disease. These findings indicate that extent and prevalence of impairment increase with progressive radiographic abnormality and that physiologic findings are useful in staging sarcoidosis.


Structure and function in sarcoidosis.

Structure and function in sarcoidosis. We have reviewed and compared our clinical, roentgenographic and histological material from 63 patients with sarcoidosis, berylliosis, and biological dust sensitivity. Among the histological features interstitial cellular infiltration proved to be the best for correlation with abnormal function, especially with arterial oxygen pressure and alveolar-arterial oxygen pressure difference at exercise, single-breath pressure and alveolar-arterial oxygen pressure differnce at exercise, single-breath diffusing capacity, forced vital capacity, and a composite index of overall functional impairment. There was also a significant correlation between pathological changes and a composite index of clinical severity. Some of the imperfections in these correlations may be related to strategic locations of granulomata that could alter ventilation-perfusion relationships, but part of the functional change remains unexplained by our histological measurements. Correlations of physiological and pathological features with radiographic parenchymal changes generally was poor except in the most severe cases. The finding of 4 cases with biological dust sensitivity or "allergic alveolitis" in this series reemphasizes that it is worth reviewing all cases of routinely labeled sarcoidosis in which the diagnosis has been based on the histological finding of granulomata. This is especially true in patients whose roentgenograms show no hilar  nodes and minimal or "groudn-glass" changes in the lung fields despite significantly abnormal lung function and also in patients who have rapid remissions and exacerbations without therapy. Almost all of the features of berylliosis overlapped those of sarcoidosis and no distinction could be made histologically. The mean values were worse in the berylliosis group and the long-term results in treated patients were not nearly as good as in the sarcoidosis group.


Membrane diffusing capacity and pulmonary capillary blood volume in pulmonary sarcoidosis.


Pulmonary function follow-up to 120 patients with sarcoidosis.


Lung water and capillary permeability in pulmonary sarcoid-like granulomatosis. The subject of our research was the use of multiple indicators to study the lungs of rats during a pathological process induced by complete Freund's adjuvant (CFA). The parameters studied were extravascular water (idQwl), the capillary permeability of [14C]sucrose, and the unrecovered fraction of [3H5glucose. We ascertained that idQwl gives a valuable estimate of total pulmonary water (r=0.91, n=30) and allows a satisfactory quantification of granulomatosis, as is shown by the comparison between the values of idQwl measured at different stages of the lesional process with average number of nodules per slice of right middle pulmonary lobe. The capillary permeability of sucrose is normal both at early and late stages of the CFA granulomatosis process. The fraction of [3H]glucose not recovered increases significantly (p less than 0.001) during the initial stage of the CFA process. This apparent loss of indicator can be explained by the existence of a slow cellular compartment.


A cooperative study of sarcoidosis in Asia and Africa: analytic epidemiology. The characteristics of about 2,000 Japanese sarcoidosis cases collected by the Japan Sarcoidosis Committee during the 10-yr period, 1963-1972, were chronological increase with decreasing infectious diseases (represented by tuberculosis), north-to-south decline in sarcoidosis incidence in accordance with the Oxford Atlas Seasonal Climates, the age of cases shifting to the younger group in areas of high incidence, a local outbreak, and familial aggreagations. These results led the authors to an hypothesis that sarcoidosis is a disease induced by an infective agent or agents, prevalent in cold places, becoming influential in association with ecological changes, and affecting persons with predispositions.


A worldwide review of sarcoidosis.

A worldwide review of sarcoidosis.


A cooperative study of sarcoidosis in Asia and Africa: descriptive epidemiology. An eight-nation cooperative epidemiological study revealed the Asian and African features of sarcoidosis. Almost every country reported from several to less than 30 cases, except for Japan which had already collected over 3,000 cases. Not a single case was found in the mass x-ray surveys conducted by several countries on a large scale (Tables 1 and 2). Although the number of the cases included in this study were small, this information is the first of this kind for Asia and Africa.


Sarcoidosis in Europe: a cooperative study. The data on the epidemiologic situation of sarcoidosis from 24 countries of Europe have been reviewed. The new facts seem to demonstrate that the differences between the frequency of this disease in the north and south are not real. The actual situation is dependent on the general knowledge of this disease and on the extent and intensity of the active detection of its asymptomatic stage. A new prospective cooperative study of the yearly incidence of all forms of sarcoidosis in the total population of at least some European countries would be desirable.


Racial differences in sarcoidosis.

Racial differences in sarcoidosis.


Patterns of sarcoidosis in three population groups in New York City. Caucasians in this study group presented in the chronic stage of sarcoidosis more frequently than the Blacks and Puerto-Rican-born. 2) Twenty-eight percent of the Caucasians and 26% of the Blacks who presented in the chronic stage of sarcoidosis, died of pulmonary insufficiency. 3) Puerto-Rican-born women are especially prone to present with erythema nodosum and Stage I radiographic sarcoidosis.  4) Sarcoidosis with extrathoracic organ involvement was more common in Black and Puerto-Rican-born patients than in Caucasians. 5) The size of the Kveim papules was larger in the Black and Puerto-Rican-born patients than among the Caucasians. 6) Two-thirds of all groups were insensitive to tuberculin. 7) The extent and duration of disease at presentation is a major determinant prognosis. 8) Ethnic factors influence the clinical patterns in sarcoidosis, but socioeconomic factors may preclude generalizations based solely upon clinic populations in New York City.


Familial sarcoidosis: a possible genetic influence.


Familial sarcoidosis with multiple occurrences in eleven families: a possible mechanism of inheritance. Among 80 Black patients with sarcoidosis, 11 families were identified as containing multiple cases. Monogenic modes of inheritance were reasonably excluded by informal inspection of pedigree patterns and by poor fit of corrected ratios within sibships to the expected ratio for all sibships at risk. The observed familial distribution conforms in several respects to properties that are descriptive of multigenic traits. Additionally, heritability based only on female probands was estimated to be between 60% and 70%. A larger sample size should permit analysis of additional multigenic properties.


The optic pathway in neurosarcoidosis.

The optic pathway in neurosarcoidosis. A case is reported of a patient, age 40 yr, with progressive hypothalamic and visual failure. Autopsy revealed widespread multisystemic sarcoidosis with involvement of the central nervous system. The intracranial portion of the optic pathway was diffusely infiltrated by sarcoid granulomas. Comparison of this case with previously reported autopsy and biopsy findings leads to the following conclusions: 1) The intraocular, intraorbital, and intracranial parts of the optic nerves may be involved independently; 2) lesions of the nerve head and of the retrobulbar part of the nerve may be unilateral; and 3) involvement of the intracranial portion is usually bilateral and forms part of more widespread sarcoidosis of the central nervous system.


Gougerot-Sjögren syndrome and sarcoidosis.


Sarcoidosis of the upper respiratory tract and its relation to lupus pernio. The authors present a personally studied series of 32 patients with sarcoidosis affecting the upper respiratory tract and nose. Twenty-five of these patients had lupus pernio (LP), which in 8 instances was accompanied by sarcoidosis of the upper respiratory tract (SURT). The 7 other patients had SURT (mucosal disease) without LP. There was a female to male ratio of 7:1. SURT presented mainly in the third decade, whereas LP presented mainly in the fourth and fifth. Despite this, SURT was as much a chronic manifestation of sarcoidosis as LP. Five of 11 patients (45%) presenting with SURT progressed to LP within 2 yr. Overall 26 patients (81%) had intrathoracic sarcoidosis, 19 patients (59%) had skin lesions other than LP, 10 patients (31%) had bone sarcoidosis, 7 patients (22%) had ocular lesions, and 6 patients (19%) had peripheral lymphadenopathy. The Kveim-Siltzbach skin-test was positive in 12 of 12 patients with SURT, making it a useful aid in the differential diagnosis of sarcoid granulomas in the nose. Two patients had nasal perforations, both of which followed a submucous resection.


Hepatic granulomata: problems in interpretation. Granulomata occur in the liver not only in patients with systemic granulomatous disease, but also in a variable number with underlying liver disease and in a heterogeneous group of disorders that appear to be neither hepatic nor granulomatous in nature. The hepatic granulomata found in association with liver disease are rarely attributable to complicating systemic granulomatous disease, and probably represent a nonspecific response to the underlying hepatic disease. In the heterogeneous group of diseases that appear to be neither hepatic nor granulomatous in nature, hepatic granulomata may (in some instances) represent a nonspecific response to such conditions as intraabdominal malignancy and ulcerative bowel disease. However, in others, particularly those with unexplained prolonged fever, hepatic granulomata may be attributable to specific agents that are overlooked or escape detection by currently available diagnostic measures. The etiology of hepatic granulomata can seldom be established on histological grounds alone, and usually requires collateral clinical and laboratory evidence for identification.


Ocular sarcoidosis: evaluation of intraocular findings. Intraocular lesions occurred in 55 of 70 sarcoidosis patients (78.6%) and their intraocular findings were biomicroscopically analyzed. Intraocular lesions were observed bilaterally in 54 of 55 patients (98.0%) and these various lesions occurred simultaneously or within a short period in almost all tissues of the eyeball. From these characteristics a new attempt was made to correlate the presence of sarcoidosis with intraocular findings. A gross positive correlation was revealed between the number of active intraocular lesions and the presence of sarcoidosis. Four to six active, bilateral intraocular lesions were found only in sarcoidosis. Although the correlation was not statistically tested, it should be clinically very useful in managing patients with suspicious intraocular lesions. Among the causes of visual disturbances secondary glaucoma was the most frequent. In 41 (37.2%) eyes various degrees of intraocular hypertension were observed. Impairment of aqueous outflow due to nodular infiltration of trabeculae was the fundamental mechanism in the rise of intraocular pressure. It should be emphasized that this peculiar trabecular finding can be identified only by a trained ophthalmologist and is very frequent in and characteristic of ocular sarcoidosis.


LP-X test in sarcoidosis patients with liver involvement: comparison with other liver function tests. In the serum of many patients with sarcoidosis, alkaline phosphatase activity is increased due to sarcoid liver involvement. A study was carried out of various tests expressing intrahepatic cholestasis in 26 patients with sarcoidosis, 18 of them with a positive liver biopsy and 8 with a negative liver biopsy. SAP was elevated in 23% of the patients and its thermoresistance pointed to an hepatic origin. The predictive value of a positive test (PV-positive, the percentage of times that a positive test is in agreement with an involved liver) and the predictive value of a negative test (PV-negative, the percentage of times that a negative test will detect a nondiseased liver) were calculated. LP-X test is more reliable than SAP, which in turn is better than CB, BSP retention, and gamma-glutamyl-transpeptidase, in that order. LP-X seems to be more specific and more sensitive than alkaline phosphatase for predicting liver involvement in sarcoidosis.


Clinical course of cardiac sarcoidosis.

Clinical course of cardiac sarcoidosis.


Clinicopathological study of fatal myocardial sarcoidosis. Presented here was an outline of fatal myocardial sarcoidosis in Japan based on 42 autopsy cases. The incidence, clinical features, pathological findings (particularly the distribution of sarcoid lesions in various organs, and gross as well as histological patterns have been reviewed. The ratio of fatal myocardial sarcoidosis to the total number of sarcoidosis deaths is higher than that of other countries and it appears characteristic of Japanese sarcoidosis that the disease occurs here predominantly after the fourth decade in females. Only 12% of myocardial sarcoidosis cases are diagnosed exactly. Conduction disturbances and dysrhythmias due to myocardial damage are its most common manifestations. The modes of presentation or cardiac death are sudden death, 16 cases (41%); congestive heart failure, 9 cases (23.1%); Adams-Stokes syndrome, except sudden death, 7 cases (17.9%); death due to dysrhythmia, 6 cases (15.4%); and 2 pacemaker deaths among the application of pacemakers, 7 cases. As for the ECG findings, A-V block and bundle-branch block was observed in most cases and ectopic beats were also frequently observed. The difficulty in exact diagnosis of myocardial sarcoidosis appears to be due to the frequency of lack of manifestation of systemic sarcoidosis as well as insidious cardiac involvement. The gross findings on myocardial lesions showed 3 patterns and each of the localized patterns corresponded to the histological extension. The conglomerate-band-like pattern corresponded to expansive invasion, the dendrite pattern to interstitial extension. The histological findings on the myocardial lesions were classified into four types: 1) exudative type, 2) granuloma type, 3) combined type of granuloma and fibrosis, 4) fibrotic type. Two extreme cases showed the exudative and fibrotic type, respectively, and were discussed.


Bone sarcoidosis.

Bone sarcoidosis. Sarcoidosis of the bone has been observed in 24 patients for up to 43 yr. It was always present in hands and/or feet and also elsewhere in 4 other patients. Soft-tissue swelling preceded the radiological abnormality for up to 4 yr in 9 patients accompanied it once, followed it once, and was absent in 13 (55%). Bone involvement was usually an incidental finding when sarcoidosis presented elsewhere, including lupus pernio (50%) and other chronic skin lesions (41%), lungs (75%), eyes (51%), lymph nodes (21%), liver (17%), spleen (13%), parotids (13%), facial palsy in 2 patients and erythema nodosum in 1. Pulmonary infiltration, with or without lymphadenopathy, was evident in three-fifths of the patients and hilar adenopathy alone in one-fifth. Sarcoid tissue was observed in the bone, but not in the surrounding soft-tissue swelling of 2 amputated fingers. There were 3 types of bone lesions: a) Lytic in 20 patients; minute 1-mm cortical defects or larger, usually rounded defects that on healing become corticated leading to punched-out "cysts". b) Permeative in 8 patients; these showed progressive cortical tunnelling with remodelling of trabecular and cortical architecture. c) Destructive in 3 patients, with secondary joint-surface involvement and in one a periosteal reaction.


Gallium scanning in sarcoidosis.

Gallium scanning in sarcoidosis. This study of 36 patients, 27 with sarcoidosis, confirms the avidity of mediastinal and pulmonary sarcoidosis for gallium-67. This procedure may prove useful in distinguishing enlarged hilar vessels from lymph nodes. Gallium scanning proved unsuccessful, however, in detection of clinically important extrathoracic sarcoidosis and appears to have limited applicability in the diagnosis of thoracic sarcoidosis.


Flexible-bronchoscope biopsy of lung and bronchial wall in intrathoracic sarcoidosis. 1) Twenty of 25 patients (80%) with sarcoidosis had positive lung biopsies obtained by flexible-bronchoscope biopsy. 2) Three of the 5 negative biopsies were in patients with chronic sarcoidosis whose chest radiograph was unchanged for 1 yr or more. 3) Two insignificant pneumothoraces occurred as a complication of the bronchoscopic biopsy procedures. 4) Noncaseating epithelioid-cell granulomas found on fiberoptic bronchoscopic biopsy are no more specific for the diagnosis of sarcoidosis than similar findings in any other organ biopsy.


Fine-needle aspiration biopsy of the spleen in diagnosis of sarcoidosis. Splenic fine-needle aspiration is a simple, safe bedside procedure by which cells typical of the sarcoid granuloma can be rapidly detected. Not only does it appear to be a valuable diagnostic procedure, but it offers a reliable method for demonstrating multisystem involvement in sarcoidosis.


Further observations on the transmissibility of Crohn's disease. In controlled experiments normal and immunologically deficient CBA mice were inoculated with whole fresh, fresh autoclaved, fresh supernatant, or filtered supernatant (0.2 mu) of whole Crohn's or non-Crohn's homogenate into footpads, intraperitoneally or intravenously. Epithelioid and giant-cell granulomas were present in a substantial proportion the footpads and in bowel or mesenteric lymph nodes of a proportion of given each fresh Crohn's homogenate by any of these routes 15-17 months after inoculation, but were not present in mice given non-Crohn's or autoclaved Crohn's homogenate. Successful passages were achieved following the inoculation of Crohn's mouse tissue homogenates, including passage from mice receiving filtered supernatant (0.2mu) or whole Crohn's homogenate, into footpads or intravenously. The epithelioid- and giant-cell granulomas evolved slowly over a period of many months following the inoculation of Crohn's tissue or passage homogenates and persisted thereafter. The transmissible agent is inactivated when homogenate from Crohn's tissue is autoclaved, can be passaged successfully into footpads or intravenously, and has been shown to pass an 0.2 mu membrane filter. It is therefore presumably viable and must approximate to the size of a virus or be capable of being deformed to pass a filter of such a pore size (0.2mu).


Serum lysozyme and beta-glucuronidase in experimentally induced granulomatous inflammation.


Comparison of clinical and laboratory findings of intrathoracic sarcoidosis between children and adults. Children were different from adults in the following findings of intrathoracic sarcoidosis: All of the 69 pediatric patients studied had no complaints and were found by chest x-ray examinations, in contrast with 71% of the 62 adult patients studied. At the ages 10-14 yr there were far more boys than girls. In pediatric patients eye involvements were rare, blood eosinophilia was more frequent, biopsy of conjunctival follicles was more frequently positive, cold serum hemagglutinins were higher at first and decreased later, and the prognosis was far better than in adults.


Sarcoidosis and other granulomatous diseases of the lung: clinical aspects and problems of differential diagnosis.


Induction of granulomas in mice by inoculation of tissue homogenates from patients with inflammatory bowel disease and sarcoidosis.


Midline and Wegener's granulomatosis.

Midline and Wegener's granulomatosis.


Eosinophilic granuloma of the lung and the extrinsic pulmonary granulomatoses.


The first seven cases of chronic beryllium disease in ceramic factory workers in Japan. In the present paper the first 7 cases in Japan of chronic beryllium disease found in workers employed in a ceramic factory utilizing beryllium have been described. Immunological examinations of these cases showed changes similar to those observed in sarcoidosis, that is, negative tuberculin test and increase in serum gamma globulin and immunoglobulins. The fact that a considerable number of workers in the same factories as the patients showed negative tuberculin reaction may suggest that there may be further cases of chronic beryllium disease among them that are still in a latent period.


Qualities and behavior of satisfactory Kveim suspensions.


Current (1975) problem of differentiating between beryllium disease and sarcoidosis.


The Kveim test: analysis of results of tests using colindale (K 12) materials. Results of an analysis are presented of the salient clinical, pathological, and Kveim-test data of importance in the diagnostic assessment of 839 patients in whom a Kveim test was made as part of their routine clinical investigation. From these analyses the following significant observations can be made: 1) The age distribution and negative tuberculin results in patients with sarcoidosis were in keeping with the diagnosis of sarcoidosis, whereas for those in whom a diagnosis other than sarcoidosis was made, they were not. 2) The findings of 64% positive tuberculin results in cases of confirmed sarcoidosis of less than 2 yr known duration and only 39% in those of greater than 2 yr duration are closely similar to those found in international Kveim-test studies reported by Siltzbach in 1966 and Hurley and Bartholomeusz in 1971. 3) The use of the material was helpful in confirming a diagnosis of sarcoidosis in patients with extrathoracic lesions, for positive results were obtained in 33% of those with uveitis 40% of those with erythema nodosum only (findings which are in keeping with those of other studies in the United Kingdom, and 60% among 27 patients presenting with lesions in various sites, including 2 with cranial nerve lesions and one with cardiac arrhythmia. 4) We found only 2 positive reactions (less than 1%) among 221 patients in whom a diagnosis other than sarcoidosis was reached. Clearly these findings show that the Kveim test material. Lots 19 and 22, of spleen K 12 exhibited not only a high degree of reactivity and selectivity for sarcoidosis, but also that they were of considerable practical value as an aid to diagnosis. The finding of only 2(0.9%) positive Kveim tests among 221 patients with diseases other than sarcoidosis is of special interest. Of the different diseases that were ultimately diagnosed only 6 patients tested had lymphoma, only 11 had either pulmonary or lymphatic tuberculosis, and only one had Crohn's disease. Although these numbers are small, it is relevant to compare the Kveim-test data of Lots 19 and 22 of K 12 with those of Lot 5 and of Lot 14 of the same spleen. In validation studies Lot 5 yielded the expected proportion of positive reactions at different stages of sarcoidosis and a negligible proportion of positive reactions with active or quiescent pulmonary tuberculosis or among healthy subjects. However, in subsequent studies in special groups of patients, those with Crohn's disease, ulcerative colitis, or lymphatic tuberculosis, a proportion of the Kveim tests performed with these lots were positive. Within the context of the present field  study, the results of these analyses confirm that the last lots of K 12 material exhibited a high degree of selectivity for sarcoidosis and that they emphasize again the practical value of the Kveim tests with suspensions that have undergone careful validation.


The Edinburgh spleen: source of a validated Kveim-Siltzbach test material. Although it is true that some Kveim-Siltzbach test suspension may for reasons unknown behave in a totally nonspecific way and so be useless in the confirmation of active sarcoidosis, the experience with the Edinburgh spleen has shown that it is also true that a preparation can be made which acts specifically in the sarcoid context and fulfils all the Siltzbach criteria. The active principle probably resides in the membrane components of sarcoid tissue cells.


Comparative in vitro reactivities of leukocytes from sarcoids and normals to different Kveim preparations. Comparative studies of in vivo and in vitro reactivities to Kveim preparations have been carried out in 45 sarcoid and 30 normal subjects. Lymphocytes of 14 of 45 sarcoids and 4 of 30 normals proliferated significantly in response to at least 1 of the 4 Kveim suspensions used for in vitro studies. The prevalence of positive responses were significantly greater in sarcoids than normals in cultures containing Kveim-CSL and Kveim-Edinburgh. The Kveim-reactive cells were less stimulated by PHA, but no other significant alterations were found, including the presence or absence of in vivo Kveim reactivity in the cell donors. Reactivity to more than 1 Kveim preparation occurred in 9 of 14 cases. Kveim-induced leukocyte migration inhibition occurred more commonly in sarcoids than normals, but differences were not as striking. There was not a precise correlation between proliferative and migration-inhibition responses to Kveim.


Experience with a Dutch kveim suspension in men and guinea pigs. A Kveim antigen was prepared according to the Chase-Siltzbach method from the spleen of a patient with sarcoidosis. This antigen was tested in a number of patients with sarcoidosis or possible sarcoidosis and also in a number of non-sarcoid patients. Several lots prepared from this spleen were compared, yielding differences in reactogenicity. Maybe this can be explained by heterogeneity of the spleen. An animal model (the BCG-presensitized guinea pig) is presented that may be applicable for a preclinical evaluation of lots of Kveim antigen.


International Kveim histology trial.

International Kveim histology trial. An histological analysis of Kveim-test biopsies performed on a total of 306 patients including those with sarcoidosis, Crohn's disease, tuberculosis, and collagen disease is presented. Five main Kveim suspensions, "antigens," were used in the survey, Colindale K 12, Lot 5, Marburg 2 and 3, Commonwealth Serum Laboratory (CSL) early batches, 001/2/3 and late batches, 005/6. The biopsies were read blind by two observers (overall agreement 75%), the nature of the antigen and disease later disclosed, and the finding statistically analysed. It was agreed that focal epithelioid-cell collections remain as the essential criteria for the diagnosis of Kveim positivity. Diffuse epithelioid cells, Langhans' giant cells, lymphocytes, and necrosis are associated with focal epithelioid cells and hence Kveim positivity. Steroids were found to inhibit Kveim positivity. Observer disagreements were mainly due to difficulties in distinguishing macrophages from true epithelioid cells. We conclude that doubtful cells should be ignored in deciding Kveim positivity. Lymph-node-derived Kveim antigens were the most sarcoid-specific. They were more granulogenic and produced more necrosis, despite also producing the most foreign material. It is recommended that validation of new Kveim antigens must include adequate testing on patients with Crohn's disease, as the more nonspecific antigens were shown to give equal positive rates in sarcoidosis and Crohn's disease.


Prognosis of chronic sarcoidosis.

Prognosis of chronic sarcoidosis.


The problem of the treatment of sarcoidosis: Report of the Subcommittee on Therapy. Stage I: Hilar Adenopathy With normal lung function observe, as it often resolves. With reduced lung function observe for 6-12 months. Treat if there is progression or persistence. With erythema nodosum use mild anti-inflammatory agents such as salicylates or like drugs. Stage II: Adenopathy + Pulmonar Infiltrates With normal or slightly reduced lung function observe; treat if it worsens. Treat if there is no remission in 6-12 months. With reduced lung function treat, possibly for many years or a lifetime. Stage III: Pulmonary Infiltrates +/- Fibrosis Without Adenopathy There is reduced lung function. Treat, demonstrate improvement, follow patients with serial measurements of vital capacity at least. Other Indications for Treatment Other indications for treatment include myocardial sarcoidosis, cerebral sarcoidosis (although the outcome is less certain), serious hepatic or renal sarcoidosis, hypercalcemia, persistent systemic symptoms, or other serious organ or functional impairment. Assess each patient individually and completely. Use good clinical judgement. It is clear that treatment that is too little or too late is of little benefit. Even the statistical results form a perfectly controlled study cannot provide absolute direction for the individual patient. As clinicians we are frequently called upon to apply considered judgements without hard data to predict the outcome. We also maintain the flexibility to change our therapeutic programs when circumstances change, either in the patient or in our knowledge. We can be grateful we have a treatment as good as corticosteroids and must try to exercise our best judgement as to when it should be instituted.


Description of sarcoidosis: Report of the Subcommittee on Classification and Definition.


Extended experience in the long-term corticosteroid treatment of pulmonary sarcoidosis. A 15-yr experience with symptomatic pulmonary parenchymal sarcoidosis treated with corticosteroids has included 250 patients. Within the past 5 yr 192 patients have been actively studied and these are reported in detail. Varied clinical observations are described. Serial measurements of vital capacity and steady-state carbon monoxide diffusing capacity were performed. All of these patients were sufficiently symptomatic and incapacitated to require treatment. Ninety-one percent were Black, 72% were female, and 72% were in the third and fourth decades. In response to treatment there was overall clinical improvement and an increase in vital capacity in 150 (83%) of 180 patients, although only a temporary increase in 12 of these patients. By contrast, only 82 (46%) showed an increase in carbon monoxide steady-state diffusing capacity and only temporarily in 19 patients. Changes in vital capacity correlate well with changes in symptoms and the radiographic appearance and are of great assistance in assessing the clinical course and need for continued treatment. The diffusing capacity is more difficult to interpret. Continued treatment was required in 74 patients (48%) because of recurrent clinical relapses as treatment was withdrawn. Such relapses were observed in 70% of the patients. Improvement and discontinuation of treatment was achieved in 66 patients (42%). In the 44 in whom there was no observed relapse, 34 were treated for less than 2.5 yr. In the total group, longer periods of treatment, 2.5-10 yr or more, were required in 104 patients (54%). In this series of 192 patients there were 7 deaths, with 22 deaths in the total 15-yr series of 250 patients. Of these, 18 were directly attributed to the sarcoidosis. Clinical improvement coincident with corticosteroid treatment and the frequency of relapse as treatment is withdrawn strongly support the benefits of corticosteroid treatment for symptomatic pulmonary sarcoidosis. When relapses occur and recur, retreatment is necessary and often long-term maintenance doses of prednisone (10-15 mg daily) are required for many years. The relatively infrequent problems related to this treatment are greatly exceeded by the clinical benefits.


An elective in the United States: two students visit Harvard.


A beginner's guide to surgery planning (Part II).


Growth hormone deficiency after treatment of acute leukaemia in children. Growth hormone (GH) secretion was studied in 15 children at various times after treatment for acute lymphatic leukaemia. Impaired GH responses both to hypoglycaemia and to Bovril were found in 4 children. 13 of the children had been given prophylactic cranial irradiation of either 2500 rads in 10 fractions or 2400 rads in 20 fractions. The reduction in GH responses in those given the former dose was highly significant compared with the reduction in those given the latter dose. However, other differences between the two groups included the length of time since cranial irradiation and the chemotherapy used. The main cause of the GH deficiency is not yet clear, but we conclude that it may occur in children treated successfully for acute lymphatic leukaemia.


Diagnosis of parasitic diseases by filtration.


Search for new treatment approaches in schizophrenia: in vitro studies of potential N-methyltransferase inhibitors. Partially purified rabbit lung N-methyltransferase (NMT) was used in an in vitro assay to screen various amines and substrate analogs as potential inhibitors, N-Methyltryptamine (NMeT, 10(-3 M) and 14C-S-adenosyl-L-methionine (14C-SAM, 2.5 X 10(-5) M) were used as substrates to form 14C-N, N-dimethyltryptamine (14C-DMT). By thin layer chromatography the product was identified as having the same Rf as authentic DMT. Of 129 compounds studied S-adenosyl-L-homocysteine (SAH), 2-(2-aminoethyl)-5,6-dichlorobenzimidazole dihydrochloride (SKF No62817-A2), DMT, an equimolar mixture of adenosine plus DL-homocysteine, N-(2-aminoethyl)-pyrrolidine, and 2-(2-aminoethyl)-pyridine showed definite inhibitory properties. These constitute potential lead compounds for further research.


The George Adlington Syme oration: about suffering they were never wrong, the old masters.


Dominant inheritance of McArdle syndrome. Myophosphorylase deficiency (McArdle syndrome) is an uncommon condition characterized by exercise intolerance, muscle cramping, and myoglobinuria. Although the original report by McArdle dealt with a sporadic case, subsequent cases reported in the literature show high familial incidence and consanguinity, implying that the defect is transmitted as a rare recessive gene or a possible sex-limited mode of inheritance. The present report describes the clinical, histoenzymatic, and biochemical findings in a 40-year-old woman with myophosphorylase deficiency. The family history reveals that four other members are also affected: an older sister, a younger brother, a 10-year-old son, and her 75-year-old mother, and possibly her maternal grandmother. Because of this particular pattern of direct transmission in this family, a dominant inheritance is postulated.


Postbulbar duodenal ulcer.

Postbulbar duodenal ulcer. Postbulbar duodenal ulceration is not common, but when present is difficult to diagnose and treat. Between January 1965 and September 1971, 1,080 patients with duodenal ulcers were treated surgically at St James Hospital. Forty-one ulcers were found at operation to lie distal to the duodenal bulb. Pain was the most common indication for surgery. In six-patients it was clinically indistinguishable from biliary pain, giving rise to diagnostic difficulty. Twelve patients (29%) presented with haemorrhage, a percentage similar to the 25% of bulbar ulcers presenting with this complication over the period of this study. This is contrary to the finding in most other series, that postbulbar ulceration is more frequently complicated by haemorrhage than is bulbar ulceration. Perforation and stenosis are uncommon complications. Postbulbar ulceration is easily overlooked in conventional barium studies. Only one-third of the patients subjected to barium meal x-ray examination had their ulcers identified in the first study. In a further third the presence of an ulcer was suspected, and the remainder required multiple investigations for undiagnosed symptoms before the condition was demonstrated. Duodenoscopy was not performed in a sufficient number of patients for its value to be assessed, but other reports indicate that it should be a valuable manoeuvre. The technical difficulties and potential hazards of Polya gastrectomy are discussed and special reference is made to the surgical management of bleeding postbulbar ulcers.


Multiple hyperplastic inflammatory polyps complicating quiescent ulcerative colitis. A patient with well-controlled and currently asymptomatic ulcerative colitis had II unusually large polypoid lesions in his colon demonstrated by barium enema X-ray examination and colonoscopy. Previous histological descriptions of inflammatory polyps did not adequately describe their morphology, and the term "hyperplastic inflammatory polyp" is suggested.


Closure of colostomy.

Closure of colostomy. A retrospective review of 110 patients who had their colostomies closed during the period from 1963 to 1973 has been undertaken. Their average age was 64 years. Diverticular disease and colorectal cancer had been the most frequent indications for the colostomy. Wound infection occurred in 36.4% and faecal fistula in 7.3%. These complications occurred less frequently in patients who had antibiotic bowel preparation. The overall mortality rate was 4.5%. Measures to reduce the morbidity and mortality are discussed.


The Kock continent ileostomy: a preliminary report. A review is presented of seven patients who have undergone a continent type of ileostomy, as described by Professor Kock. There has been no mortality. Two of the early patients had considerable difficulty with the functioning of the valve and required re-operation. No patient in the series now wears an external appliance. Six of the seven are fully continent; the seventh reports occasional leakage, but is satisfied with the operation. The operation is considered to be still under trial, but is regarded as having great potential and likely to be much more widely practised in the future.


The first 15 years' experience with vagotomy and drainage for duodenal ulcer at the Royal Prince Alfred Hospital, Sydney. The first 15 years' experience with vagotomy and drainage for duodenal ulcer at the Royal Prince Alfred Hospital, Sydney is summarized in a retrospective study. Proved ulcer recurrence in 16% of patients, a mortality rate of 2.6%, and a postoperative complication rate of 32% suggest that vagotomy and drainage as the procedure of choice in all patients with chronic and complicated duodenal ulcer should be reconsidered. The delay in recognition of ulcer recurrence and the increase in the number of patients with longer follow-up show disturbing similarities to the recurrence of ulcer after gastroenterostomy alone.


Mesenteric venous thrombosis associated with oral contraceptives: a case report. Small-bowel infarction resulting from mesenteric venous thrombosis is a rare but life-threatening complication to which young women taking oral contraceptives are liable. The patient characteristically presents with an "acute abdomen" after a variable prodromal period of vague abdominal pain. The correct diagnosis can be made from the macroscopic appearance at laparotomy, provided the surgeon is alert to the condition. An accurate diagnosis is important, as anticoagulation measures must be instituted early to counter the commonly associated thromboembolic phenomena. A case report of mesenteric venous thrombosis with small bowel infarction in a 38-year-old woman who had been taking oral contraceptives is reported.  The patient was admitted complaining of severe abdominal pain and vomiting for 36 hours.  On admission, temperature was 37.5 degrees C and pulse 120/minute.  Abdominal rigidity and left-sided abdominal tenderness were present.  X-ray of the abdomen showed 2 distended loops of small bowel and 3 fluid levels.  Serum amylase was normal.  White cell count was 10,000/cu mm.  There was a history of abdominal pain and diarrhea over a period of several years.  For 6 months she had been taking Ovulen (mestranol .1 mg and ethynodiol diacetate .5 mg) for menstrual irregularity.  2 weeks earlier she had suffered an influenzalike illness with pleuristic chest pain, loin pain, urinary frequency, and dysuria.  Chest X-ray and intravenous pylography were then reported as normal.  At immediate operation, a 15 cm segment of ileum was found to be infarcted.  Semipurulent fluid was present in the abdomen and areas of fibrinous peritonitis were observed.  The involved segment of ileum was resected.  A small thrombus was extracted from a mesenteric vein.  Initial postoperative course was good but 3 days after operation chest pain, dyspnea, and giddiness developed and cardiac arrest followed.  Resuscitation was successful.  Pulmonary angiography then showed thrombi in all branches of the pulmonary artery.  After heparin therapy symptoms improved and the patient left the hospital in 2 weeks, her condition being stabilized with warfarin and dipyridamole (Persantin).  The diagnosis was confirmed by histological examination.  Early recanalization of a mesenteric vein was noted.  Other reported cases have shown an average prodromal phase of 4 or 5 days.  The long-term diarrhea was considered as not connected with the present illness but the presumed influenza illness 2 weeks earlier may have been due to a pulmonary embolism.  Of reported cases, 5 of 13 have died.  Early diagnosis, prompt surgery, and heparin therpay are considered important.


Needle biopsy of bone: a simplified technique. By means of a slight modification of a commonly available needle, adequate amounts of bone for histopathology examination have been obtained from deep-seated bones, including vertebral bodies. Forty-one correct diagnoses were made in 51 consecutive cases in which the technique was used.


The management of vertebral artery insufficiency in cervical spondylosis: a modified technique. Vertebrobasilar insufficiency may on rare occasions be caused by cervical spondylotic spurs. These can be cured by a minor procedure, and a plea is made for avoidance of fusion in such patients.


The use of a posterior-based tongue flap for the closure of a pharyngocutaneous fistula. The closure of a pharyngocutaneous fistula by the use of a posteriorly based tongue flap is described. The use of such a flap for this purpose has not been  previously recorded in the literature.


Carcinoid tumours of the biliary tract.

Carcinoid tumours of the biliary tract. Data on 13 patients, including two not previously reported, with carcinoid tumours of the biliary tract are reported. In ten of them the primary tumour was located in the gallbladder and in three in the biliary duct. No specific symptoms were recorded, and the carcinoid syndrome has not been reported in carcinoid tumours of the biliary tract. In five patients the tumour was first found at autopsy. Metastases were found in three patients at operation or autopsy. Cholecystography can show either a functioning or a non-functioning gallbladder. Some patients had concretions in the gallbladder. The prognosis appears to be good, and one of the patients reported survived 20 years with metastases.


Chronic subdural haematoma in the elderly. A series of 20 patients over the age of 60 years, all suffering from chronic subdural haemotoma, is reviewed. Factors leading to diagnostic errors are emphasized. Burr-hole aspiration supplemented by adequate measures to aid in reexpansion of the brain remains the primary choice of treatment in this condition.


Occupational compression of the common peroneal nerve at the neck of the fibula. Seven cases of common peroneal nerve compression were seen among farm workers. The symptoms followed working in a sitting position with forward advancement, a position commonly adopted in India for harvesting a crop and hoeing. Motor and sensory impairment was seen in the distribution of the common peroneal nerve, more marked in the distribution of the deep peroneal branch. Motor conduction time, estimated in two cases, was delayed. At exploration, the cause of the compression was found to be a tendinous arch extending along the posterior border of the peroneus longus, and curving backwards and upwards along the lateral border of the soleus. Excision of this arch, with elimination of the origin of the upper part of the peroneus longus, led to disappearance of the neurological deficits.


Thymectomy for myasthenia gravis.

Thymectomy for myasthenia gravis. A group of 71 patients with myasthenia gravis is reviewed. All were initially managed medically, and 18 underwent thymectomy. Twenty-three responded poorly to drug treatment, and seven died from respiratory failure. In contrast, thymectomy was beneficial in 16 of the 18 who were subjected to operation. Seven patients had significant postoperative respiratory complications, and nine required a tracheostomy. Thymectomy appears to be effective and safe and to be indicated in young patients with early disease, and in patients who do not respond to drug treatment. The transcervical approach to thymectomy was satisfactory on two occasions.


Granulomatous mastitis.

Granulomatous mastitis. Granulomatous mastitis is a benign mammary lesion, which clinically can closely simulate breast cancer. The condition has only recently been recognized, less than a dozen cases being recorded in the English literature. Two further cases are presented, the histological features are illustrated, and the literature is reviewed. Case studies of 2 instances of benign breast lesions diagnosed upon histological examination as granulomatous mastitis are presented.  Both patients were young, and the lesions occurred within 5 years of last delivery.  Histologically the lesion is characterized by diffuse infiltration of the lobules by inflammatory cells and by microabscesses in the absence of duct dilation.  Simple excision appears to be the correct treatment.


Hysteroscopic sterilization with quinacrine sulphate and electrocoagulation.


Primary rhabdomyosarcoma of the heart: a case report, with autopsy. A case of rhabdomyosarcoma of the heart in a 45-year-old man is reported. The diagnosis was suspected because of refractory congestive cardiac failure, a bulge on the left cardiac border, and was confirmed histologically at necropsy.


An appraisal of clomiphene in the induction of ovulation.


Artificial donor insemination.

Artificial donor insemination.


Interaction of AML cells and normal hemopoietic cells: replacement or inhibition?


Genetic control of Friend virus-transformed colony-forming cells by the Fv-2 resistance gene in mice.


In vivo interference of virus-induced osteosarcomas by a benign bone tumor virus.


Expression of viral and/or hemoglobin antigens in Friend virus erythroleukemic cells treated with dimethyl sulfoxide and/or interferon.


Experimental studies with maytansine--a new antitumor agent.


Workshop discussion...

Workshop discussion...


Chemoimmunotherapy in human and experimental leukemia.


Analysis of host mechanisms involved in suppression of established Friend virus leukemia.


Comparative prognosis of the acute leukemias.


Control of normal cell differentiation in leukemic cells.


The dentists register.

The dentists register.


President's address at the opening of the forty-third session of the General Dental Council.


Amalgam restorations and periodontal disease.


Hard words.

Hard words.


Presidential address.

Presidential address.


Valedictory address.

Valedictory address.


The microbiology of angular cheilitis.

The microbiology of angular cheilitis.


Inferior alveolar nerve blocks. The use of 5 per cent lignocaine.


Secondary hypertrophic osteoarthropathy. An unusual cause of arthritis in childhood. Although an uncommon occurrence in childhood, hypertrophic osteoarthropathy secondary to tumors- most commonly to osteogenic sarcoma with pulmonary metastasis-may cause severe join pain and swelling. The syndrome should be considered in the differential diagnosis of acute arthritis in childhood


Report of the forty-third session of the General Dental Council.


Emergency dental services in the Plymouth area. Report over a 10-month period.


The branches.

The branches.


Gross localised maxillary resorption due to occlusal forces. A case report.


Dose reduction in dental radiography. Control of exposure time and film processing.


Dental problems in Antarctica.

Dental problems in Antarctica.


The apical border of plaque in chronic inflammatory periodontal disease.


Working party on women in the B.D.A.

Working party on women in the B.D.A.


Editorial: Resources for dental education.


A tax on health.

A tax on health.


University examination performance of dental students. Correlation between entry qualifications and non-clinical examinations.


An introduction to clinical practice. The development of an undergraduate course.


The value of tests of spatial and psycho-motor ability in selecting dental students.


A factor influencing dentists' choice of practice location.


Dentists and doctors: the concept of the professional man.


What are they doing now?

What are they doing now?


Undergraduate training for dental practice. Experience in Glasgow.


A new link needed.

A new link needed.


Mercury intoxication in a dental surgery following unreported spillage.


Persistent limitation of opening following inferior alveolar nerve block injections.


Economies of scale in dental practice.

Economies of scale in dental practice.


School meals.

School meals.


Granulocyte function in chronic granulocytic leukemia. II. Bactericidal capacity, phagocytic rate, oxygen consumption, and granule protein composition in isolated granulocytes. The initial rate of phagocytosis, oxygen consumption rate during phagocytosis, bactericidal capacity against Escherichia coli, and the granule protein composition of isolated mature-appearing granulocytes were studied in 23 patients with chronic granulocytic leukemia (CGL) with the simultaneous use of normal controls. The initial rate of phagocytosis was decreased (p less than 0.05) in the CGL patient group, as were oxygen consumption rate (p less than 0.001) and bactericidal capacity (p less than 0.001). Kinetic analysis of the ingestion rate showed CGL granulocytes to have the same capacity to bind the particles as normal granulocytes. Both specific and primary granule protein deficiencies were shown for CGL granulocytes, and these deficiencies were more pronounced at or near blast cell transformation. Analysis of all different granulocyte function parameters showed an inverse correlation to white blood cell counts (p less than 0.01) and to the percentage of immature granulocytes in peripheral blood (p less than 0.001). The leukocytosis doubling time was progressively shortened during the chronic course of the disease. A correlation was found between granulocyte function parameters and leukocytosis doubling time (p less than 0.001), indicating that granulocyte function was progressively deteriorating during chronic phase CGL, and may be an expression of increasing disturbance of the differentiation process.


Morphological discordance in acute leukemia.


5q-Acute myelogenous leukemia.

5q-Acute myelogenous leukemia.


Further education teacher's course.

Further education teacher's course.


The media and nutrition: focus on weaning.


Platelet and fibrinogen survival in acute promyelocytic leukaemia.


The development and clinical application of fissure sealants.


Training is important.

Training is important.


People who play with fire ... often get burned!


Contamination and resterilization of the Bain circuit. Fifty Bain circuits were tested for contamination following single patient use. A contamination rate of 8 per cent was found. Two methods of resterilization were examined. Sterilization by activated glutaraldehyde proved unsatisfactory, while ethylene oxide sterilization was found to be an effective method which produced no detectable adverse physical or chemical alterations of the circuits.


Myophosphorylase deficiency (McArdle's disease): report of a family. The clinical and biochemical findings are presented of two brothers suffering from McArdle's Disease (Myophosphorylase Deficiency). Tissue enzyme estimations and lactate levels were done in affected and non-affected members of the family. Affected members showed absence of phosphorylase enzyme by histochemical and quantitative estimation. No quantitative abnormalities were found in other enzyme systems of glycolytic pathways in the family investigated. Various other aspects of clinical features, biochemical abnormalities and inheritance are discussed.


A radioautographic study of chondrocytic proliferation in nasal septal cartilage of the prenatal rat. Six pregnant female Sprague-Dawley rats were labeled with tritiated thymidine and killed, one each day, during the terminal six days of pregnancy. Nasal septal cartilages of five pups from each litter (a total of pups in all) were monitored radioautographically for cellular proliferation. It was found that chondrocytes were moderately active mitotically on gestational day 16, showing 12.1 grains per microscopic field. Activity increased sharply the following day (16.5 grains/field) then declined slightly on day 18 to a 16.1 count. There was a marked drop on both the 19th and 20th days (13.1 and 10.3 grains/field respectively) followed by a leveling off on the 21st day (9.3 grains/field). No specific location in the septal cartilage could be identified as a growth center. The area of highest proliferative activity varied from day to day, being seen in the nasal tip on day 16, centered in the middle two-thirds of the cartilage twenty-four hours later, then moving caudally to the posterior one-half the following day (day 18). On day 19, a final shift back to the middle of the septum was observed. It was impossible to identify an active zone anywhere within the septum of either the 20- or the 21-day prenatal rat.


Cephalometric comparisons of the results of the Wardill-Kilner and Von Langenbeck palatoplasties. Two groups of individuals with isolated clefts of the palate were compared. One group had had the Von Langenbeck procedure performed at the University of Iowa and the other the V/W-Y (Wardill-Kilner) procedure performed in Denmark. All individuals in both groups were Caucasians. In order to avoid the influence of any possible ethnic differences on the interpretation of the results, each cleft group was initially compared to a matched non-cleft group from the same geographical area. Differences were then statistically evaluated using the Student t-test. The incidence of malocclusion in the two operated groups was compared using Chi Square. Different landmarks were pricked on duplicate cephalograms. Nine angular and four linear parameters were measured. Two ratios derived from these linear parameters were also computed. The results of this study tend to indicate that these two procedures have similar effects upon antero-posterior and vertical growth of the craniofacial complex as determined from cephalometric roentgenograms. While there were no statistically significant differences in the incidence of malocclusion, the need for a detailed study of the effects of different palatoplasties on dental occlusion was emphasized. Speech results and dental occlusion emerge as critical factors in the evaluation of the effects of these two surgical techniques.


Bilateral congenital choanal atresia and absence of respiratory distress. Bilateral congenital choanal atresia is considered a lethal congenital malformation in an obligatory nasal breathing neonate. Described herein are two cases of bilateral choanal atresia associated with craniofacial anomalies who did not present respiratory distress in the neonatal period. Our first patient had a complete unilateral cleft lip which facilitated oropharyngeal respiration. The second patient presented wory distress in the neonatal period by providing an oropharyngeal airway.


Cleft palate and congenital palatopharyngeal incompetency in mandibulofacial dysostosis: frequency and problems in treatment. In a series of 25 cases of mandibulofacial dysostosis, 7 patients had isolated clefts of the palate, 1 had a complete unilateral cleft of the lip and palate, and 8 had congenital palatopharyngeal incompetency (CPI). The CPI appeared in four forms: (a) complete agenesis of the soft palate, (b) foreshortening of the soft palate associated with a submucous defect of the hard palate, (c) submucous defect of the hard palate with adequate palatal length but inadequate elevation in speech, and (d) lack of adequate palatal elevation in the absence of a submucous defect or reduced length of the soft palate. Inadequate velopharyngeal function, whether congenital or subsequent to palatal repair, may be masked by the presence of other speech problems in this syndrome, particularly by the "muffled" voice quality which appears to be associated with an elevated and retracted tongue posture. Both prosthetic and surgical treatment of inadequate velopharyngeal function are complicated in patients with MFD by other structural anomalies, particularly inadequate oral opening and constriction of the airway.


"Basket suspension" as an adjunct to tongue flap closure of hard palate defects. Proper suspension of a tongue flap is necessary to prevent detachment and allow proper healing when used to repair palatal fistulae. Our use of an aluminum suspension basket to prevent flap tension and motion has facilitated inset of the flap resulting in healing per primum in 31 consecutive patients.


The Peabody Picture Vocabulary Test as a measure of intelligence in children with palatal problems. The Peabody Picture Vocabulary Test and the Wechsler Intelligence Scale for Children were administered to 33 children with palate problems. The correlations between PPVT and Wechsler IQ's ranged from .45 to .50 indicating that the Peabody is only a moderately good predictor of WISC scores in this population and suggesting that its utility in cleft palate children is limited. Additional data on the PPVT-WISC relationships are also presented and discussed.


Neonatal intensive care unit: basic equipment needs. Intelligent selection and use of neonatal equipment are essential for quality care. Desirable features of monitors, ventilators, and diagnostic-therapeutic equipment are elucidated.


A 2-year retrospective study of demand for dental care from Scottish school leavers. After leaving school young adults in the United Kingdom are no longer eligible to receive care from the School Dental Service. Patients who have previously been treated by the Service are obliged to seek care elsewhere. The aim of the study was to see how effectively a group of Scottish school leavers coped with the change. The study population was 912 school leavers. The method depended upon a retrospective study of clinical records relating to the year before leaving school and the following year. During the last year at school, 48% of the subjects received treatment from three sources: 30% were treated by a general practitioner, 19% by the school service and 2% by the hospital service. During the 2nd year of the study, 69% of those who had earlier been treated by a general practitioner again requested dental care compared with only 40% of those who had earlier been treated by the school service and 30% of those who had not sought dental care during their last year at school. Recommendations are made for encouraging an increased demand for care from those who have formerly been treated by the school service.


Effectiveness of a dental education program on oral cleanliness of schoolchildren in Israel. The purpose of this study was to examine the effectiveness of a dental health education program providing dental health information and toothbrushing instruction on oral cleanliness. Two methods of instruction, individual and group instruction, are presented in this study. The plaque situation was assessed in a group of 175 children, 11-14 years of age, by the Patient Hygiene Performance (PHP) method at the beginning of the study and at 1, 2, and 12 months. It was found that immediately after instruction the dental health education program resulted in improved oral hygiene home care for the two experimental groups. However, the improvement noted was achieved regardless of the method of toothbrushing instruction (individual versus group). Moreover, it was demonstrated that maintenance of a satisfactory level of oral hygiene home care was dependent upon review of educational programs and toothbrushing instruction and not related to the method of instruction.


Public attitudes concerning water fluoridation in Denmark. Attitudes towards water fluoridation were assessed in a national probability sample of 1,600 adult Danes. 23% favored and 48% opposed water fluoridation while 29% didn't know. Differences in opinion were found in relation to sex and age, occupation, residence, and dental behavior. Compared with an earlier Danish study, a shift towards more expressed opposition to water fluoridation seems to have taken place.


The effect of professional toothcleansing on gingivitis and dental caries in children after 1 year. The purpose of this study was to determine the effects of professional mechanical toothcleansing on plaque, gingivitis, and dental caries in young children with a high caries experience. Seventy-eight children, 7 years of age, were stratified according to presence or absence of smooth surface lesions on the permanent teeth and subsequently randomly assigned to an experimental group and a control group. The experimental group was given a thorough mechanical toothcleansing every 2 weeks. After 12 months a statistically significant difference in plaque accumulation and a minor difference in level of gingival inflammation could be demonstrated between the two groups. The incidence of dental caries in permanent teeth present at both examinations was 70% lower in the experimental group. The effect on permanent teeth erupting during the study and on primary teeth present at both examinations was not statistically significant.


Retention and effectiveness of a chemically polymerized pit and fissure sealant after 12 months. The aim of the present study was to evaluate the retention and effectiveness of a bis-GMA type of fissure sealant which polymerizes after conventional mixing of the two catalyst/activator components (Concise Enamel Bond System). Unilateral sealing of homologous pairs of permanent first molars was carried out by a dental hygienist. Of the 451 sealed sites sealant was present in 73%, partly missing in 8%, and completely missing in 18% after 1 year. The effectiveness of the treatment in preventing occlusal caries was highly significant and the caries reduction was found to be about 70%. A strong relationship between status of sealant and occlusal decay was demonstrated. The shortcomings of the half-mouth design when evaluating sealants as a caries-preventive measure in public dental health programs are discussed.


A study of molar tooth form.

A study of molar tooth form.